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Home My WebLink About12067-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ..... z1370¢. ..... THIS CERTIFIES that the building ........ a. qtql~.~.5, 9~g: .............................. Location of Property ..... '192P. .............. I~Ij_~r~lgO]x.a..~.ly.d. ,. ........ .S. qu.~..kp.~.d...' House No. Street Hamlet County Tax Map No. 1000 Section ...... ~.~ ....Block ......... 3 .....Lot .... .~.2..&...~.~. .... Subdivision ............... X. .............. Filed Map No....x ..... Lot No ....... .x. ..... conforms substantially to the Application for Building Permit heretofore fried in this office dated November fl7 1982 pursuant to which Building Permit No. ~2057Z dated ..... .D.e.c.e.m?. !'~..~ ........... 198.2. .. ,was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... Additiom ~o existing dwellir~. J. LOUISE & GERALD O. FiOYI~ The certificate is issued to ..................... ?o'~n¢),~) ...................... of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE NO... N599~ ~ 0 Building Inspector Rev. 1/81 ~ NO. · TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HA~.L SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 1~067 Z ~ Tax map mo. 1000 Section .............. ~,,.~. .... Block ..................... ~ No ............... j,, ....... pursuant to application dated ........................................... Z ........ , 19 ........ , and approved by the Building Inspector. F. Rev. 6/30/80 FDF[M NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southo~d, N.Y. 11@71 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor with the following; for new buildings or new use: 1. Final sur.,ey of property with accurate location of all buildings, property lines, streets, and unusual natural or tooo~rachic features. 2. Final approvai of Heaith Dept. of water supply and sewerage disposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial build'rigs, Industrial buildings, Muir[pie Residences and similar building~ and instella- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings {prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate sur,zey of peoperty showing all property lines, ~treets, buildings and unusual natural or topographic features. 2.Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tlon required to prepare a certificate. · C. Fees: / 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling7' land use st 5.00 3. Copy of certificate of occupancy $1.00 Date ..... New Building ............. Old or Pre-existing Building(Z) ......... ~/Vacant Land ............. County Tax Map No 1000Section .... ~ ..... Block ... }~ ........ Lot.~. ~.~... Subdivision ......... ~ ...................... Filed Map~ ~_ .._. ~,~ ..._..._~No.~'.:~..~...Lo~. ..~ ....... Health Dept Approval ......... ]...: ......... Labor Dep~ Approval .... ~ ....... ~ ...... ~ / - Under,vriters Approval ........................ P~anning Board Approval .................. ' Request for Temporary Certificate ..................... Final Certificate .............. · 6 · Fee Submitted S ..................... Construction on above described building a 'nd p~ets all a~p[~~and FIEL~INS?ECTION FOUND~TtO~ FOUNDATION (2nd) 2. ROUGH FRAME & FLUMBING 3. INSULATION PER N. Y. STATE ENERGY FINAL ADDITIONAL COMMENTS: FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL File No ................................ To x~.~../.~.~.~....~ ./;. ......... · .c~y~ .o....~T. ~ ~.~..../~..:. · .,~.~4~o/~x. ~. ,~ .......... PLEASE TAKE NOT ICE that y our application dated ...,~q~. ~. for pe~it to construct..~Z~] ~..~.~({~ ................. at Hou~ No. St~t / Ham/et County Tax Map No. 100~ Section ...~ .... Block . .~. ~. ...... Lot .~.~/~ Subdivision ................. Filed Map No ................. Lot No .................. is returned herewith and d~sapproved on the follow~g grounds ~.(~.~.. ~. ~ ~/~~ ~ .. ................................................... Bufld~g Inspector FIV 1/80 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 8S JOHN STREET, NEW YORK, NEW YORK 10038 THIS CE~IFIES THAT ~e ~yle, ~ blvd., ~u~l~, N.Y. in the following tocatlon; ~ B~ement ~ Ist Fl. ~ 2nd FI. ~ Section Bl~k ~ exami~d on April '~-, ~ and found to be in compliance with the requirements of this Board. RXTURE RXTURES RANGES OVENS DISH WASHERS EXHAUST FANS DRYERS FURNACE MOTORS TIME CLOCKS MUtTI-OUTtET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT S E R V I C ~ou~hold, N.Y. ll~'il ~c~7 This cedificate must not be altered in any manner; return to the office of the ~ard if incorrect. Inspectors may ~b~e~ COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER, YORK STATE DEPAP~MENT OF E~.{VIPDNbT..NTAL CONSEMVATION Regulatory Affairs Unit Bldg. 40, SUb,'f--Recto 219 Stony Brook, ~Y 11794 (516) 751-7900 ~.0. Moyle 1920 Minnehaha Blvd. Southold, N.Y. 11971 December B, I9B2 RE: Constructing addition to existing residence~ Dear Mr. ~ovle: A reView has been made of your proposal to: Construct an addition to your existing residence, Location: 1920 Minnehaha Blvd., $outhotd Lagoon off Corey Creek New York State Department of Environmental Conservation has found the __parcel , ~ 'project to be: " Greater than 300' from inventoried tidal wetlands. X Landward of a substantial man-made structure _bl~<bm~ m~ a~m~" greater than 10D' in length constructed prior to September 20, 1977. Landward of 10' contour elevation above mean sea level on a gradual, nat- ural slope. Lan~;ard of topographical crest of bluff, cliff or dune in excess of 10 feet in elevation above mean sea level. Therefore, no permit under Article 25 (Tidal Wetlands of the EnVironmental Conservation Law) is rmquired at this tima since the current proposal is beyond State ~dated ~uriediction pursuant to ~is act. However, any additional ~rk or modifications to tha project may require a petit. It is your responsibility to notify this office, in writing, if such additional ~rk of modifications are contemplatad. Very truly yo~u~s;~. D~niel Ra glona~l~upe rviso r of RegulatSry Affairs DJL:RNT:cz FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 - / Disapproved a/c ............................ .~ ...... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tltis application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public stree or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appl cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such penn shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupanc shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances c Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe, The applicant agrees to comply with all applicable laws, ordinances, building code, housing cpde, and regulations, and t admit authorized inspectors on premises and in building for necessary inspecJd~,r~s.t ~//f/2 (S~f~nature of applicant, or name, if a corporation) ....5'"'..J'.q~.....~..~/~. ,,<¢'.,4Z .//.,'4"¢:..4¢/4¢., .......... (Mailing address of applicant) _~o ,,.?t~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buildei ... ~'~.~.~.'?..9 .... q.o.<q..C4:~..e. ~.a.¢. ........................................................... Name of owner of premises ..... .¢.~.~..~.d.~. .... .O.,....~..o..Y.~. ¢ .... .~......~.,...4.0?. {.~..~- .................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...... 3 .'~..?. ......... 1. Location of land on wbich proposed work will be done ................................................. ............................... . ./~./.~..~.~..,q~,g..~...g'.z.q.~., ............. .~).-...r~A~..o. ............... House Number Street Hamlet County Tax Map No. 1000 Section .... 0'?~. ......... Block .... O..~ ........... Lot...~.&.. ?..6~.-~ ....... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intendefi$)use and occupancy of proposed construction: a. Existing use and occupanoy ..... '.. ~J~.~ .~i...< ./.~¢3~./7. q..~....(~(a~.~.~ .................. '.,. b. Intended use and occupancy C~/~' ~ .~'~' ''~ . .~.. 3. Nature of work (check which applicable): New Building .......... Additiofi .......... Alteration ......... Repair .............. Re~noval .............. Demolition .............. Other Work .............. ~ Description) 4. Estimated Cost ) .O.o..o. ........................... Fee ..................................... (to be paid on filing this application) 5. If dwelling, number of dwetling units ............... Number o f dwelling units on each floor ............... If garage, number of cars .... O..~.~. ............................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .................... 7. Dimensions o~ existing structures, if any: Front .... ~o. 2'' ...... Rear ...,,~'.o/ ........ Depth ...~. 9. t. ....... Height . .~9 ........... Number of Stories .... ~..~.$ ............................................... Dimensions of same structure with alterations or additions: Front ................. Rear ................. Depth ...................... Height ...................... Number of Stories ..................... 8. Dimensions of entire new construction: Front .... .J.9~. ........ Rear .... /.'?~. ........ Depth .. ,2..o ......... Height ..... /.~..r ....... Nmnber of Stories ....... ~..~..~ ............................................ 9. Sizeoflot: Front ....... /.6'.5". ........... Rear .... ;~it~';.~'. ........... Depth .. ~.o. ~. ............. 10. Date of Purchase ............................. Name of Former Owner ............................ 1 1. Zone or use district in which premises are situated .................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ............................... 13. Will lot be regraded ............................ Will excess fill be removed from premises: Yes N, 14. Name of Owner of premises ...... . ....../r*/4Y..t~;.. Address . ~ !W.,?$~,~/td.,~..~.qq~.,. Phone No.. 7..~..~. Name of Architect ..... ~.~J[ .~.~..)'...~?.~..~.~.- ..... Address ~4 .x~. 4'.~:. ~..~-Av~.. q .rz~... Phone No.. T.~.. Name of Contractor .../tffo.~..~.~..~...,~,. A~'.~'. ~.~. .. Address S~Caa ~4/.a,'~.~'./~.~'~.,.. Phone No..?~'.~'. 7 ~,O~]7.~t~. PLOT DIAGRAM Locate clearly and distinctly 'all buildings, whether existing or proposed, and. indicate all set-back dimensions fron property lines. Give street and block number or description according to deed, and show street names and indicate whethe interior or corner lot. STATE OF NEW, YORK .... ~ S $ COUntY OF .~.(5.'¢/.~.~//( · . ........... /~Z~.~..../.~. c..~..~f*./ ............... being duly (Name of individual si~paing contract) above named. sworn, deposes and says that he is the applican He is the ........................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file thi application; that all statements contained in this application are true to the best of his knowledge and belief; and that th work will be performed in the manner set forth in the application filed therewith. Sworn to before me this / __ ........ .... · .,. ............. day of ........... Notary Public, ..~. ..... No. 52.452~771 (Signature of applicanl · : ' '~ THE' ' I '~ FiNAl CO~U~ON MUST ;,,